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BY: FARWA MOLOOU29/35723/2010
SUPERVISOR: DR AMUGUNE
INTRODUCTIONDiabetes growing epidemic threatening to overwhelm
health services and undermine economies, especially in the developing countries( WHO, 2008).
Diabetes is a chronic disorder characterized either by: inability of the pancreas to synthesize and secrete
insulin or properly utilize insulin resulting in chronic
hyperglycemia.
…….If diabetes is not managed appropriately,
complications can arise including:Skin infectionsGlaucomaCataractsDiabetic footDiabetic ketoacidosis
•Gastroparesis
•Hypertension
•Diabetic Neuropathy
•Stroke
INTRODUCTION…
To achieve optimum control of condition important
consideration on:
Compliance to pharmacological management
Compliance to non pharmacological management
Laboratory support: glucose , lipid and glycated hemoglobin level
measurements.
A pharmacist’s role crucial
STUDY RATIONALE
Studies show most health care workers in
developing countries aim only to provide the
patients with medications but without appropriate
information on: lifestyle, medications side effects importance of medication compliance.
a pharmacist can reduce prevalence by having an appropriate pharmaceutical plan for medication related problems
STUDY OBJECTIVESOverall objective
To evaluate the management of diabetic patients at the out- patient diabetic clinic in Kenyatta national hospital
Specific objectivesTo assess diabetic patients compliance to their anti-diabetic
medications.To determine the factors that lead to non compliance to anti-
diabetic therapy.To explore the various approaches that may be adapted by a
pharmacist to reduce non compliance.To determine the non- pharmacological support services provided
as part of the diabetes management plan.
METHODOLOGY
Study design: a mixture of:
retrospective-patients’ files were perused,
Prospective-participants interviewed using a questionnaire.
Study Site: KNH outpatient diabetic clinic
Study population: Patients mainly resided within Nairobi.
Sample size: 140 Informed and consented diabetic patients
participated.
Study approval: KNH- UON ERC
RESULTS AND DISCUSSION 70 % of the patients were type 2 diabetics that
lay in 51 to 60 years age range
RESULTS AND DISCUSSION…Most patients adhered to their medications but did not adhere to
strict diet and exercise regimes.
67% of the patients were obese and 60 % were on blood pressure
medications.
RESULTS AND DISCUSSION…
Some type two obese patients reported not attending regular counseling sessions and experienced problems such as: Visual disturbancesNumbness/ burning sensation on the
footHigh cholesterolKidney problemsAmputation of the toe
RESULTS AND DISCUSSION…
Type one diabetics reported challenges in: Measuring insulin doseCost of the insulinForgetting to inject at the right time.
Patients checked their blood sugar often and
could detect when they were hypoglycemic from the
symptoms they experienced
However, detection of the hyperglycemic state
seemed to pose a problem in 31 % of the patients.
RESULTS AND DISCUSSION…
Patients
Were familiar with the ideal meal plan for a diabetic
exercised daily but the intensity of exercise was reported to be
easy.
RESULTS AND DISCUSSION…
Alcohol and tobacco consumption was not observed as a
problem amongst participants.
33 % were on insulin, 36 % t on tablets and the rest were on
combination therapy (insulin and tablets).
RESULTS AND DISCUSSION…Low compliance observed 10 % of the participants
due to:Cost of the medicationsLack of drug informationIgnoranceForgetfulness in the old agedIrregularities in attending diabetic clinicsPill burdenSide effects of medicinesDifficulty in measuring the dose of insulinDifficulty in adhering to time due to work constraints
RESULTS AND DISCUSSION…
41% percent of patients had been sent for HbA1CBP, weight and blood glucose were checked at every
visitPatients regularity of getting cholesterol, urine and
eye tests depended on if they could afford it.
RESULTS AND DISCUSSION…
There was no pharmacist at the diabetic clinicPatients bought their medications from a separate
pharmacy.Aim at the pharmacy was to clear the long queue
rather then counsel patients.
CONCLUSION AND RECOMMENDATIONS
There is a correlation between non
compliance to pharmacological & non
pharmacological management of diabetes and
development of complications.
A pharmacist should be incorporated in the
medical team at the diabetic clinic in order to
reduce non compliance in patients.
RECOMMENDATIONSRole of the pharmacist be :
Choosing medications that require less frequent
administration with few or no side effects
Counseling patients on expected side effects and how to
minimize them
Educating patients to keep diaries/set reminders
Counseling patients on consequences of non compliance
and regular follow up
In the assessment, identification, education, referral and
monitoring of the condition.
THANK YOU